Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
07/25/2024
Section Cited
CCR
87465(a)(5)(A)
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5
6
7 | 87465 Incidental Medical and Dental Care (a)(5)(A) Medications usually prescribed for self-administration which have been authorized by the person's physician.
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | Administrator stated to submit a written plan of action understanding regulation and will ensure physician's order is on file prior to administering medications to resident by POC due date. Administrator agreed and understood. |
 | 8
9
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12
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14 | Based on record review, interview and observation, resident R2's 7 medications did not have a signed physician's order for facility staff to administer the medication to R2 which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care. | 8
9
10
11
12
13
14 |  |
Type A
07/25/2024
Section Cited
CCR87465(h)(6)
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2
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4
5
6
7 | 87465 Incidental Medical and Dental Care (h)(6)The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year...
This requirement is not met as evidenced by:
| 1
2
3
4
5
6
7 | Administrator stated to submit a written plan of action understanding regulation and will ensure staff receive in-service training on medication managment and administration where staff will ensure recordkeeping is accurate by POC due date. Administrator agreed and understood. |
 | 8
9
10
11
12
13
14 | Based on record review, interview and observation, resident R2's Centrally Stored Medication Log had multiple medications wherein "start date" was not filled and ADM could not verify if medication was administer to R2 which poses/posed a immediate health, safety or personal rights risk to... | 8
9
10
11
12
13
14 | (con't) persons in care.
|
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
07/25/2024
Section Cited
CCR
87411(a)
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2
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4
5
6
7 | 87411Personnel Requirements - General (a)Facility personnel shall at all times... competent to provide the services necessary to meet resident needs....
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | Administrator stated to submit a written plan of action understanding regulation and will ensure staff receive in-service training on medication managment and administration where staff will ensure recordkeeping is accurate by POC due date. Administrator agreed and understood. |
 | 8
9
10
11
12
13
14 | Based on record review and interview, resident R2's medications did not have physician order and staff, including ADM were administering medication to R2 which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care. | 8
9
10
11
12
13
14 |  |
Type A
07/25/2024
Section Cited
CCR87303(a)
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5
6
7 | 87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times.
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | Administrator stated to submit a written plan of action understanding regulation and will ensure resident's safety during facility repairs by POC due date. Administrator agreed and understood. |
 | 8
9
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12
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14 | Based on observation and interview, resident bathroom had tile lifting from the floor and power outlet was not covered, exposing electric wires on the wall which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care. | 8
9
10
11
12
13
14 |  |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
07/25/2024
Section Cited
CCR
87468.1(a)(3)
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2
3
4
5
6
7 | 87468.1 Personal Rights of Residents in All Facilities (a) (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... interfering with daily living functions such as eating, sleeping, or elimination.
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | Administrator stated to submit a written plan of action understanding regulation and will ensure staff are trained on resident's personal rights by POC due date. Administrator agreed and understood. LPA Rai observed staff remove the key pad lock and install a regular door knob. |
 | 8
9
10
11
12
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14 | Based on observation and interview, the ktichen door was locked with a key pad lock and residents were not able to access food and water supply which poses/posed a potential health, safety or personal rights risk to persons in care. | 8
9
10
11
12
13
14 |  |
Type A
07/25/2024
Section Cited
CCR87405(d)
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4
5
6
7 | 87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply.
This requirement is not met as evidenced by: | 1
2
3
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5
6
7 | Administrator stated to follow up with Licensee and submit a written plan of action understanding regulation and and a plan on obtaining training on Title 22 regulations by POC due date. Administrator agreed and understood. |
 | 8
9
10
11
12
13
14 | Based on record review, interview, and observation, ADM stated she is "vaguely familiar with Title 22" and did not receive complete training when obtaining Administrator Certification a year ago which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care. | 8
9
10
11
12
13
14 |  |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
07/25/2024
Section Cited
CCR
87205
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2
3
4
5
6
7 | 87205 Accountability of Licensee Governing Body (a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility...
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | Licensee to submit a written plan of action understanding regulation and will ensure Title 22, including Health and Safety Code are followed and records are kept at the facility by POC due date. |
 | 8
9
10
11
12
13
14 | Based on record review, interview and observation, Licensee did not supervise the facility staff including the Administrator to conform with regulations such as Title 22 and Health & Safety Code which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care. | 8
9
10
11
12
13
14 |  |
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5
6
7 |  | 1
2
3
4
5
6
7 |  |
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4
5
6
7 |  | 1
2
3
4
5
6
7 |  |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
07/31/2024
Section Cited
HSC
1569.695(c)
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5
6
7 | 1569.695 Emergency Plans (c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios.
This requirement is not met as evidenced by: | 1
2
3
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5
6
7 | Administrator stated to submit a written plan of action understanding regulation and will ensure disaster drill is conducted at least quartely by POC due date. Administrator agreed and understood. |
 | 8
9
10
11
12
13
14 | Based on record review and interview, the ADM conducted last disaster drill on 1/2/2024 and ADM will schedule another drill soon which poses/posed a potential health, safety or personal rights risk to persons in care.
| 8
9
10
11
12
13
14 |  |
Type B
07/31/2024
Section Cited
CCR87412(c)
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3
4
5
6
7 | 87412 Personnel Records (c) Licensees shall maintain in the personnel records verification of required staff training and orientation.
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | Administrator stated to submit a written plan of action understanding regulation and will ensure staff files contain training records of required trainings and orientation by POC due date. Administrator agreed and understood. |
 | 8
9
10
11
12
13
14 | Based on record review and interview, ADM did not have facility staff training at the facility and could not provide records of staff trainings during today's visit which poses/posed a potential health, safety or personal rights risk to persons in care. | 8
9
10
11
12
13
14 |  |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
07/31/2024
Section Cited
CCR
87623(b)(2)(B)
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2
3
4
5
6
7 | 87623 Indwelling Urinary Catheter (b)(2)(B) There shall be written documentation by an appropriately skilled professional outlining the instruction of the procedures delegated and the names of the facility staff who have been instructed.
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | Administrator stated to submit a written plan of action understanding regulation and will ensure staff assisting resident by emptying bag receive training and document the instructions by appropraitely skilled professional by POC due date. Administrator agreed and understood. |
 | 8
9
10
11
12
13
14 | Based on record review and interview, ADM stated facility staff were verbally trained by Home Health agency but did not document the instructions and training regarding emptying the bag which poses/posed a potential health, safety or personal rights risk to persons in care. | 8
9
10
11
12
13
14 |  |
Type B
07/31/2024
Section Cited
CCR87608(a)(3)
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2
3
4
5
6
7 | 87608 Postural Supports (a)(3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.
This requirement is not met as evidenced by: | 1
2
3
4
5
6
7 | Administrator stated to submit a written plan of action understanding regulation and will ensure signed written order from physician is obtained when half-bed rails is used for mobility by POC due date. Administrator agreed and understood. |
 | 8
9
10
11
12
13
14 | Based on record review, obserbation and interview, 2 out of 12 residents using half-bed rails for mobility did not have signed written physician's order in resident's file which poses/posed a potential health, safety or personal rights risk to persons in care.
| 8
9
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12
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14 |  |